36例神经梅毒临床资料分析

对我院2010-2019年收治的36例HIV阴性的神经梅毒患者资料进行回顾性分析。36例患者中男29例,女7例;平均年龄49岁;无症状神经梅毒9例,平均年龄(36.07±8.05)岁,症状性神经梅毒27例,平均年龄(58.12±13.33)岁,差异具有统计学意义(P<0.001);脑脊液检查示:TPPA阳性36例,RPR阳性21例;白细胞升高13例;蛋白阳性24例。症状性神经梅毒组脑脊液白细胞计数、蛋白质阳性率、RPR阳性率和蛋白质定量水平高于无症状神经梅毒组,差异均有统计学意义(P=0.005;P=0.036;P=0.019;P=0.002)。     

71例症状性神经梅毒临床分析

目的：分析症状性神经梅毒的临床表现及实验室检查结果。方法：回顾分析2014年3月至2019年1月本院诊治的症状性神经梅毒患者的临床资料。数据资料统计学分析采用SPSS 17.0软件。结果：共分析71例症状性神经梅毒患者，男52例，女19例，年龄23~71岁。 20例（28.2%）有明确梅毒史，12例血清RPR滴度≤1∶4，23例1∶8～1∶32，36例≥1∶64，44例（62%）脑脊液RPR阳性。该组病例中，脑膜血管型39例（54.9%），脑膜炎型 6例（8.5%），麻痹性痴呆23例（32.4%），脊髓痨3例（4.2%）。不同临床类型神经梅毒患者中脑脊液蛋白含量四组间比较差异有统计学意义（P＜0.05），血清RPR滴度和脑脊液白细胞计数差异均无统计学意义（P>0.05）；麻痹性痴呆组脑脊液蛋白含量和RPR阳性率高于脑膜血管型（Ps＜0.05）。结论：本研究中最常见的神经梅毒类型是脑膜血管型神经梅毒。脑脊液蛋白含量水平的升高，可能预示着症状性神经梅毒实质受损的发生。     

头孢曲松钠联合阿立哌唑治疗神经梅毒伴发精神症状的疗效评价

目的：评价神经梅毒伴发精神症状患者应用头孢曲松钠联合阿立哌唑治疗的效果。方法：对我院2013年2月至2014年9月收治的神经梅毒伴发精神症状患者给予头孢曲松钠静滴，1次/天，2g/次，连续2周，联合口服阿立哌唑治疗， 10～15mg/次，1次/天，依病情及耐受程度，调整剂量，最大剂量为30mg/次，连续服用6周。记录阳性与阴性综合征量表（PANSS）评分、临床疗效总评量表病情严重程度（CGI-SI）评分及不良反应，随访3年。结果：共治疗64例患者，治疗6周后，PANSS一般精神症状评分、阴性症状评分、总评分均及CGI-SI评分均降低，与治疗前比较，差异具有显著性（均P＜0.05）。精神症状改善总有效率为65.63%（42/64）。患者不良反应发生率为14.06%（9/64），且都属于轻度不良反应。随访3年，患者RPR转阴率为96.88%（62/64），脑脊液正常率98.44%（63/64），复发率为4.69%（3/64）。结论：神经梅毒伴发精神症状患者应用头孢曲松钠联合阿立哌唑治疗可以有效改善患者精神症状，具有良好的安全性。     

81例神经梅毒患者临床特征分析

目的:分析神经梅毒患者临床特征,以期为临床神经梅毒早诊断、早治疗提供科学依据。方法:回顾性分析了81例神经梅毒患者的临床特征、影像学表现、梅毒血清学和脑脊液检测结果。结果:81例神经梅毒患者中,非三期梅毒38例,三期梅毒43例,男性患者居多;55例(67.9%)有神经梅毒临床症状和体征,26例(32.1%)无神经梅毒症状和体征。81例梅毒血液检查结果显示,TRUST阳性80例,TPPA阳性81例;74例脑脊液检查结果显示,16例(21.6%)VDRL阳性,31例(41.9%)白细胞计数>10×10~6/L,52例(70.3%)蛋白量>500 mg/L。结论:神经梅毒患者多发于男性,临床特征及影像学表现复杂多样化。临床医生应全面认识该病的临床特点,给予患者规范治疗并进行健康教育及心理护理。     

Use of Lumbar Punctures in the Management of Ocular Syphilis

Purpose: Ocular syphilis has become rare in the developed world, but is a common presentation to ophthalmology departments in South Africa. We investigated the proportion of patients diagnosed with ocular syphilis who went on to receive lumbar punctures, and determined the fraction of these who had cerebrospinal fluid findings suggestive of neurosyphilis. We aimed to determine whether the use of lumbar punctures in ocular syphilis patients was beneficial in picking up cases of neurosyphilis. Methods: Retrospective study of case notes of patients admitted to two district hospitals in Durban, South Africa, with ocular syphilis over a 20-month period. Results: A total of 31 of 68 ocular syphilis patients underwent lumbar puncture, and of these, eight (25.8%) had findings suggestive of neurosyphilis. Conclusions: Lumbar puncture in ocular syphilis patients should continue to be a routine part of the investigation of these patients; a large proportion of ocular syphilis patients show cerebrospinal fluid findings suggestive of neurosyphilis, are at risk of the complications of neurosyphilis, and should be managed accordingly.     

Neurosyphilis as a Cause of Transverse Myelitis in a Teenage Girl

Background

Syphilis is a sexually transmitted infection that was nearly eradicated in 2001 but is now making a resurgence. It has a wide range of clinical manifestations depending on disease stage. Neurosyphilis is an infrequently seen infectious disease with central nervous system involvement that can occur in either early- or late-stage syphilis. The diagnosis of neurosyphilis is challenging, primarily because Treponema pallidum, the infecting organism, cannot be cultured in vitro. This article describes a patient with neurosyphilis and reviews the epidemiology and clinical manifestations, diagnostics, and treatment of neurosyphilis.

地奈德乳膏联合怀氏乳膏治疗手部慢性角化皲裂性湿疹效果观察

目的：通过研究早期神经梅毒临床表现及诊断方法,提高对该病诊疗上的认识。方法：对我院2012～2014年诊治的20例早期神经梅毒进行回顾性分析。结果：20例早期神经梅毒血的梅毒血清快速反应素试验（RPR）、荧光密螺旋体抗体（TPPA）检测阳性;脑脊液（cFs）梅毒实验室试验（VDRL、TPPA检测亦阳性;CSF检查,白细胞数升高7例;蛋白升高11例。其中3例伴有头痛头晕症状,2例伴有视物模糊症状,15例为无症状神经梅毒。结论：脑脊液TPPA及VDRL检测有助于神经梅毒的诊断。对于病期大于1年复发梅毒、血清RPR持续阳性患者,应及早进行脑脊液检查并采取神经梅治疗。     

A case of neurosyphilis with a florid Jarisch–Herxheimer reaction

A 37 year old man with a 2 year history of progressive cognitive decline, unilateral tinnitus and deafness presented with complex partial seizures and a fever. On examination there was a sluggish right pupillary response but no other abnormal findings. Serum and CSF syphilis serology were both strongly positive. High dose intravenous penicillin therapy was complicated by a severe Jarisch–Herxheimer reaction (JHR) characterised by fever, obtundation, fluctuating upper motor neuron signs and complex visual and auditory hallucinations. These symptoms resolved over three days and the course of penicillin was completed. At discharge the patient's cognitive functioning was unchanged from the pretreatment state. He made gradual improvement over the following months but remains unable to live alone or work. Clinical, pathologic and radiologic findings of neurosyphilis are reviewed, as is the JHR, a self-limiting, systemic febrile response related to massive cytokine release that can occur in response to treatment of a number of bacterial infections. The similarities in pathophysiology of the JHR and the Septic Shock Syndrome are discussed, with particular reference to use of the JHR as a potential model for therapeutic agents in the treatment of septic shock.     

梅毒血清学试验阳性的14例梅毒患者的临床分析

目的 :讨论合并神经系统病变梅毒患者的临床表现、诊断和治疗。方法 :回顾性分析 14例梅毒血清学试验阳性梅毒患者的临床特点、血清学变化、影像学异常、治疗及预后。结果 :据脑脊液结果确诊神经梅毒 6例 ,疑诊 3例 ,非神经梅毒 5例。治疗 14例 ,有效 10例 (神经梅毒 5例 ,疑诊者 2例 ,非神经梅毒 3例 ) ,无效 2例 ,死亡 1例 ,失访 1例。治疗后血清和脑脊液中TPPA转阴率低于RPR。 3例头颅磁共振扫描异常 ,治疗后改善。结论 :神经梅毒表现多样 ,脑脊液检查及RPR试验能明确诊断。